Pitron Fuel Inc.

Policyholder: *** ***
Claim Number: ***
Policy Number: ***
Date of
Loss: June 6, 2017
Type of Loss: Lightning
To Whom it May Concern:
This letter will serve as our formal response to the above referenced matter.
This loss was reported to us by the insured on June 6, as a lightning claim to the residence affecting the electrical system, appliances and vehicles occurring that day.
We spoke to the insured on June 6, 2017. The insured advised that a lightning strike had either hit close to the home or hit his truck antenna. He stated that the antenna was not working and that there were burn marks visible on the truckHe also reported that his wife’s car did not work eitherThe insured also reported three televisions, their satellite receivers, lights, outlets and the irrigation system were not working properlyMr*** advised that he would provide us with a comprehensive list of his damaged items. The coverage exclusions for the vehicles were immediately explained to the insured. We approved additional living expenses and requested that he keep all of his receiptsWe further advised the insured to contact an electrician to verify the cause and extent of his damage
Given the nature and extent of the damages we felt an inspection of the property was warranted. We assigned the inspection to *** *** *** *** to assist in determining the cause and extent of the damages
We sent a lightning affidavit/letter to the insured on June 9, requesting that he have the affidavit completed by a technician who could attest to the fact that the items claimed were damaged by lightning
*** inspected the property on June 10,
We received a call from the *** adjuster on June 19, prior to receiving their reportThe *** adjuster advised that at the time of the inspection the insured had kept requesting that he delete his photos. The insured stated that he did not want photos takenThe *** adjuster reported that several of the items claimed by the insured would need diagnostic reports to support the claim
We received the report from *** on June 20,
We received a voice message from the insured on June 21, and returned the call the same dayThe insured expressed frustration and requested a status update and the *** estimate of the damagesWe advised the insured that we were still waiting for the diagnostic reports from his electrician to confirm the lightning strike and damages and whether the damages were repairableWe advised the insured of his $2,deductible during the conversation
We spoke to the insured on June 27, to provide him with our address to send correspondence
We received a letter from the insured on June 29, containing a proposal from *** *** to diagnose the cause of loss and damagesThe proposal for the diagnosis was $19,using their hourly rate which would be two weeks at $per hour or $17,if using the square foot method of square feet at $per square feet
Due to what we felt was an excessive inspection and diagnosis fee, we decided to retain the service of an electrical engineer with *** *** *** *** to complete a site inspection to evaluate the dwelling and contents for lightning damage and also provide us with a repair cost protocolWe made the assignment to *** on June 29, and called the insured to advise him of our action plan moving forwardThe insured expressed frustration that we would not pay the diagnosis fee for his electrician
On July 7, we were copied on an email from *** to the insured advising him that they had been unable to reach him by phone and asking him to call them to set up an inspection
On July 11, we were copied on another email from *** to the insured advising him that they had been unable to reach him by phone and asking him to call them to set up an inspection. We then called the insured’s agent to confirm his contact information. We were eventually able to speak with the insured. He was very angry. He stated that his well pump was still not replaced and that all his grass and plants were dying. He advised that he had not seen an engineerWe explained that the engineer’s phone calls to reach him have been unsuccessful and that their voicemails left for him had not been returned nor had there been any response to any of the emails sent by the engineer. We advised the insured that we had been attempting to contact him to schedule the inspection, and that it had been his lack of contact and cooperation which had delayed this processThe insured stated that he felt it was not his fault, and that he is upset we had to send an engineer and would not just pay the claim based on what he asked for. We explained again the process and the documentation that was needed. The insured then expressed that it was his opinion that the *** adjuster should have been able to diagnose and estimate all the issues and that the entire process should have taken no longer than 3-days from the date of the inspection. We explained why this was not a reasonable expectation and that he needed to contact the engineer to schedule an appointment for an inspectionMr*** stated he would contact *** as requested and schedule an inspection, but reiterated that he felt this was ridiculous.
On July 17, we spoke to Mr***The insured was inquiring as to the status of his additional living expense claimHe advised that his typical expenses for groceries and dining out were $per weekWe advised him that the engineer inspection was scheduled for the following morning and we would be in a better position to discuss his claim after that
On July 19, we spoke with the engineerHe advised that he would be preparing a report for usHe advised that the insured had an electrician present at the time of his inspectionThe engineer advised that there was some lightning damage present but that the lightning damage was not as extensive as had been reportedHe advised that all the televisions were functionalHe further advised that the dryer was working and that although a bulb in the dryer was not working it was not lightning relatedThe damage to the oven was still questionable and he was going to investigate further as there were temperature fluctuations but was unsure if this was due to lightningIn addition, he felt most of the appliances were repairable and did not require replacementAlso noted was an active water leak from the ceiling in the kitchen with buckets catching the waterThe engineer stated that this was the result of the HVAC pan overflowing and was unrelated to the lightning damage and that the insured understood that this was a separate lossHe advised that a detailed report would be submitted with his final determinations
We spoke with the insured on July 22, and advised that we had still not received the engineers report
We will continue to work with Mr*** to resolve his claim. We hope our actions and efforts satisfactorily address your concerns. If additional information is needed, please feel free to contact our office.
Sincerely,
*** ***
Vice President, Marketing

Initial Business Response /* (1000, 8, 2015/06/19) */
The refund check was re-issued to you on June If you want it re-issued again to your property manager's name, you would have to provide documentation granting authority to your property manager to accept the check on your behalf
Initial Consumer Rebuttal /* (3000, 10, 2015/06/22) */
(The consumer indicated he/she DID NOT accept the response from the business.)
We do several times however everybody there says they cannot do even though we have the documentation granting authority to my property managerIf you could do what you say, could you please let us know where we should send the document to and who will re-issue the check to my property manager's name after receive the prove?
Thanks
Final Business Response /* (4000, 12, 2015/06/30) */
We have received the written request from your agent to have the check reissued to *** ***We will put a stop pay on the refund check that was issued in June and mail the new check to the address on the written request

Initial Business Response /* (1000, 5, 2015/05/22) */
Our records show that a refund check for $1,was processed on 4/23/If you still have not received your refund check, please let us know as soon as possible so that check can be cancelled and a new check issuedWe apologize that the
check was not received by you earlier
Initial Consumer Rebuttal /* (3000, 7, 2015/05/25) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Geovera was notified prior to the original date of complaint 5/8/with Revdex.com that the check had not been receivedOver days have passed *** the policy cancelation, at this time I am yet to receive repayment of policy premium and again requesting that the monies dues for the policy be refunded via check sent overnightThis will follow by a formal complaint with the Insurance Commissionors office
Final Business Response /* (4000, 9, 2015/06/10) */
We apologize that you never received the refund check that was mailed out in late AprilA replacement refund check was sent today (June 10)

Complaint: [redacted]I am rejecting this response because: most of what they say is contradicted by another statement made by other people in the company. 
for example the skylights issue first they say the received that information from the insurance agent [redacted] then at the end say they don't have it in there files.  They are able to quote the emails but somehow don't have the information 
I have provided them directly or thru the agent all the information and they still say they don't have even after stating they got it from the agent  
as for the depreciation I was told in an email that if I spent less on the replacement that the amount would be adjusted only after did they change the wording to say it had to be more than I spent  and if they had taken into consideration what I had to pay extra for in the skylights it would have been more than what they have claimed
the skylights are integrated part of the roof and as explained by the contractors that did the roof they are like any other part of the roof system  that when the roof is removed and replaced that if the skylights are not also replaced they could leak due to the way everything is interconnected the roof shingles and lights become one part of the roof  
 
you wouldn't keep the old ridge vents and reuse them on a new roof even if they are not damaged as it would or could cause a problem  the same thing with the lights  
 
I gave them all that information and they even stated they got it from my agent as well then say they don't have it  this is just another way to deny it isn't part of the roof that they forgot to include in the estimate they made and even told me the adjuster never mentioned them  my point to them was the adjuster never mentioned the roof vents but they were replace none the less and since the adjuster did nothing more than take photos and measure all to get the cost of a shingle replacement 
 
I asked when I got their estimate about the skylights and sent them everything but of course they ignored it or threw it away because they had already made their decision and closed the claim 
 
so now I have to jump threw the same hoops I already have and still get the same run around  if they want to resolve this pay me for the skylights like they should have from the beginning I spend $1600 to have the skylights replaced during the rior replacement and I am just told too bad  if they had included them I would be well over the amount they said I would have needed to spend to get any of their phony depreciation cost back  so what will be their excuse this time sorry to late or that I still have not done enough to warrant any additional payment either for the cost of the skylights or from the depreciation 
Sincerely,[redacted]

Initial Business Response /* (1000, 8, 2015/12/22) */
Our records show that the statement was accepted, the policy was indeed cancelled and a refund check of $944.46 was generated. The cancellation notice was sent but then was returned to GeoVera. We called the agent to get an updated address so...

the same thing would not happen to the refund check. The agent responded with the following address:
PO BOX 1065
[redacted] XXXXX-XXXX
On December 21, 2015, the refund check was mailed to this address.
We apologize for any confusion and trust the refund check will arrive shortly and the matter will be closed.
Initial Consumer Rebuttal /* (2000, 10, 2015/12/31) */
(The consumer indicated he/she ACCEPTED the response from the business.)

Initial Business Response /* (1000, 8, 2015/11/18) */
This letter will serve as our response to the Revdex.com Complaint XXXXXXXX. As this complaint was also reported to the South Carolina Department of Insurance I have attached a copy of that response which should address your...

concerns as well.
November 17, 2015
South Carolina Department of Insurance
P.O. Box XXXXXX
Columbia, SC XXXXX
Attn. [redacted]
RE: Insured: [redacted]
Date of Loss: September 24, 2015/0ctober 4, 2015
Date Reported: September 25, 2015/0ctober 5, 2015
Type of Loss: Wind/Water
Claim Number: FG XXXXXXXX / FG XXXXXXXX
SC DOI Document XXXXXX
NAIC #:XXXXX
Dear Mr. [redacted],
This letter will serve as our formal response to the South Carolina Department of Insurance
assistance request XXXXXX. Please be advised we are handling this claim and responding to
your inquiry on behalf of Geo Vera Specialty Insurance Company.
As this complaint involves two separate claims I will address them individually below.
FIRST CLAIM - FG XXXXXXXX
This loss was initially reported to us on September 25, 2015 as a wind loss having occurred
the prior day. The insured was called that same day and a voice mail was left.
Due to the nature of the claim it was felt that an inspection of the property was needed so
we engaged the services of Choice One Solutions to perform a physical inspection and assist
us in evaluating the loss as to the cause and extent of the damages.
We were finally able to speak with the insured on September 28, 2015. The insured advised
that the roof was damaged by a storm on September 24, 2015 and that the roof leaked in the
living room, dining room, den and bedroom. The insured also stated that the Choice One
adjuster had already inspected her home. We explained the claim process and reviewed the
policy coverage with Ms. [redacted] including advising her of the $1,000.00 others perils
deductible and the $14,500.00 wind/hail deductible on the policy.
On October 5, 2015 the insured called our afterhours reporting service stating that a ceiling fell in a bedroom due to additional rainfall. Ms. [redacted] would not confirm with us if it was new damage or in an area already damaged.
A new claim (FGXXXXXXXX) was set up with an October 4, 2015 date of loss and will be discussed separately below.
On October 6, 2015 we called the insured and advised her we needed to determine if the
damages from this second event should be handled under her initial claim or if they should
be subject to a separate claim. The insured advised that the damages from October 4, 2015
event were in the same area as the initial claim. We advised that we would need to review the
field adjuster's reports to confirm.
We received the Choice One report on October 14, 2015. The report indicated that the roof
inspection revealed wind damage throughout the entirety of the roof with many missing
shingles noted. It was indicated to them by the insured that a tornado had passed [redacted] five
miles of the insured's property (Charleston news reports confirmed an EF-2 tornado in the
early morning hours of September 25, 2015.) The Choice One Adjuster also noted hail
impacts to the soft metals on the roof and that the shingles were old and worn. The report
recommended a roof replacement and noted water damage to the ceilings in the kitchen,
living room, bedrooms 1,2 and 3 and hallway. The damage was estimated to be $12,120.99 which was less than the insured's windstorm/hail deductible of $14,500.
A letter was sent to the insured on October 22, 2015 explaining that the damages were less
than her deductible and we would be closing our file.
On October 29, 2015 we received an email from Ms. [redacted] asking about the process for
disputing the findings and cause of this claim. She stated in her email that there was no
windstorm in [redacted] on this date.
We responded to the insured's email on October 30, 2015 advising her via email that our
inspection of her roof revealed wind damaged shingles in the form of numerous missing
shingles. We also pointed out the Choice Solutions adjuster reported that she told him a
tornado had passed [redacted] the area with strong wind gusts. Additionally, we advised her
that the photos taken by the Choice Solutions adjuster supported that the roof had been
damaged by wind. I have attached some of these photos for your review. We then asked the
insured that if she did not believe this to be wind damage, what she thinks would have
caused this damage. We asked Ms. [redacted] to submit any documentation she might have to
support another cause of loss but to date have not heard back from the insured.
SECOND CLAIM - FGXXXXXXXX
As stated above we were initially advised of this claim on October 5, 2015. Due to the
nature of the claim it was felt that a re-inspection of the property was needed so we again
engaged the services of Choice One Solutions to assist us in evaluating the loss as to cause
and extent of damages.
On October 5, 2015 we spoke to the insured who advised that there was no damage to her
home from wind or hail.
We spoke to the insured on October 6, 2015 and advised her that we had not received the
Choice Solutions report yet. Ms. [redacted] stated that the adjuster had called her and advised
that he could not inspect due to flooding.
On October 13, 2015, the insured called and spoke with our Claims Manager indicating that
she was upset that the Choice Solution adjuster had not re- inspected yet. Our Claim
Manager stated that flood waters in her area may have receded, but maybe not others. We
advised that we would contact the Choice Solution adjuster for her. The insured was also
upset about her $14,500.00 windstorm/hail deductible. We explained to her that if her roof
was damaged from wind and/ or hail, then that deductible would apply. Ms. [redacted] stated
that the roof was not damaged. We advised that if the roof was leaking simply from the
large amount of rain received, then the $1,000 deductible would apply. Ms. [redacted] then
advised that the roof was damaged but not from wind or hail but by rain. We explained that
rain cannot damage a roof. Ms. [redacted] then stated that the roof was damaged by wear and
tear. We then advised in that scenario the roof would not be covered at all, only the interior
water damage. She was not happy with this explanation either and we explained to her that
the policy would respond only for direct physical damage and that if the roof was simply old
and in need of replacing, the policy would not pay for that.
The re-inspection done by Choice Solutions revealed that there was no additional roof
damage not noted from the initial claim. The interior inspection noted that the ceilings were
damaged in the master bedroom and bathroom and those were not in evidence from the initial claim. The damages in bedroom number three were noted to have worsened and the ceiling had collapsed and damaged a sofa. To give the insured the benefit of the doubt we afforded coverage for the sofa and attributed it to a roof leak since the leak was located in an area below the wind damage on the roof. This way we could give her the benefit of here lower $1,000 other perils deductible and be able to pay her something for this second loss. A check was issued to the insured based on the estimate of $2,102.03, less the $1,000.00 deductible for a net settlement for the dwelling of $1,102.03. In addition we allowed $138.79 for the damaged sofa. Payments were issued on October 22, 2015.
On October 23, 2015 the insured called and advised that she did not want us to pay this
claim at this time as she was talking to people and getting advice. We informed her that we
were required to pay this claim unless she wanted to withdraw it. We asked her at this time
to let us know if that was what she wanted to do. Since that time we have not heard from
her as to her decision. The estimate of the damages from the initial claim is $12,120.99. If we had added the estimate of the second claim of $2,102.03 and $138.79, the damages would have added up to $14,361.81 and would have still been less than her windstorm/hail deductible. By paying the damage from October4, 2015 under the second claim, we were able to give the insured
$1,240.82. There would have been no money due if we had handled this as one claim The insured's complaint states we denied the claim to repair her home. That is not the case. It was covered, but less than the applicable policy deductible. The check we sent her was not based on Sl4,000 worth of damages as her complaint states, but rather based on the damages from the second claim of $2,240.82. As you can see we have been fair with the insured and have strived to give her the benefit of the doubt and the benefit of the most coverage throughout the handling of her claim. As to her comments directed to her agent I would point out that they are not agents of Geo Vera
Specialty Insurance but rather represent the insured as agents of the insured.

Initial Business Response /* (1000, 8, 2016/01/05) */
What follows is a high level summary of events regarding changes and communication on Mr. [redacted]'s policy.
On December 10, 2015, Mr. [redacted]'s insurance agent called GeoVera and stated that Mr. [redacted] had made changes to the "Request Changes...

to Property Details" form removing items but the coverage/premium increased. GeoVera advised the agent that the form also included some additions. The agent was also advised that a reduction in coverage form was available. A copy of the Amended Declarations and an Insured Request to Reduce Coverage Limit form were emailed to the agent.
On December 22, 2015, GeoVera received a signed Insured Request to Reduce Coverage Limit form. The reduction in coverage limit was being processed, but not completed due to Mr. [redacted] requesting that his policy be cancelled.
On December 23, 2015 GeoVera reached out to Mr. [redacted]'s agent to confirm that Mr. [redacted] would like to cancel his policy. The agent confirmed that Mr. [redacted] does not wish to have a policy with GeoVera. On that same date, a cancellation letter was sent to Mr. [redacted] notifying him of the cancellation of his policy effective November 30, 2015.
On December 28, 2015 GeoVera sent Mr. [redacted] a premium refund check in the amount of $541.00.
We trust that the cancellation of the policy and the generation of the premium refund check resolves the matter.
Initial Consumer Rebuttal /* (2000, 10, 2016/01/06) */
(The consumer indicated he/she ACCEPTED the response from the business.)
I did receive a full refund from GeoVera and this resolves the issue.

Policyholder:             [redacted]
Claim Number:     [redacted]
Policy Number:         [redacted]
Date of...

Loss:             February 7, 2017                    
Type of Loss:             Wind
To Whom it May Concern:
We initi[redacted] received this claim on February 8, 2017 with a cause of loss listed as wind. The loss description advised that during the storms overnight of February 7, 1017 the wind had caused damage to several shingles and the ridge cap on the roof.
 
Given the nature and extent of the damages we felt an inspection of the property was warranted.  We assigned the inspection to [redacted]) to assist in determining the cause and extent of the damages.
The [redacted] inspection of the property took place on February 14, 2017 and the report was received in our office on February 16, 2017.
We reviewed the [redacted] report on February 17, 2017.  The report indicated that the inspection had found wind damage to the roof warranting replacement.
On February 23, 2017 an actual cash value payment of $6,413.61 was issued based on the [redacted] adjuster’s estimate of $12,859.58, less recoverable depreciation in the amount of $2,385.97 and application of the insured’s windstorm/hail deductible of $4,060.00.  A settlement letter that also explained the recoverable depreciation and how to make a claim for it was sent at this time.
On February 28, 2017 Mr. [redacted] called the [redacted] adjuster advising that he had sent two estimates to him. We returned a call to both Mr. and Mrs. [redacted] on February 28, 2017 and left a message advising that a copy of our adjuster’s estimate was on the way to them and that we would only need a copy of their contractor’s estimate if it exceeded the [redacted] estimate. Addition[redacted], we advised that they would need to select a contractor prior to submitting estimates to us and to notify us prior to the start of repairs if their contractor’s estimate exceeded ours.
We received a call from Mr. [redacted] on March 1, 2017 questioning the application of the $4,060.00 deductible. We advised that per the policy, the windstorm/hail deductible was $4,060.00 and the Section I deductible is $1,000.00. We further advised that the claims department could not change the deductible and he would need to speak to his agent to change his deductible for future losses. Mr. [redacted] explained that his agent stated to him that he only had a $1,000.00 deductible. We advised that the windstorm/hail deductible applied to any loss due to wind or hail. Mr. [redacted] questioned why the deductible was so high and we advised again that he contact his agent. We then also advised Mr. [redacted] to review his policy documents where it lists the Section I and Windstorm/Hail deductibles.
On March 2, 2017 we took a call from the insured’s agent’s office from [redacted], who confirmed the windstorm hail deductible. We explained to [redacted] that the damage to the insured’s property was due to wind.
On March 7, 2017 we received a call from the insured’s agent, [redacted], who advised that the insured was requesting a supplement for the skylights. We advised the agent that we would need a request for the supplement in writing from the insured which the agent understood.
On March 16, 2017 the insured’s agent, Mr. [redacted], forwarded an email to us from Mr. [redacted] regarding the skylights. Initially, it appears Mr. [redacted] had been communicating with his agent.  Mr. [redacted] wrote an email to his agent, Mr. [redacted] on March 2, 2017 with a copy of our estimate. Mr. [redacted] expressed frustration with our application of depreciation and the application of his deductible.
Mr. [redacted] reached out to us via email for an explanation of the depreciation applied on March 2, 2017. We replied on March 18, 2017 advising that depreciation applied to all items that are being replaced based on the age and condition of the existing item(s) or building. The depreciation would be recoverable after repairs or replacement had been completed and we received the final invoice for the repairs. We advised that the recoverable depreciation would be based on the cost incurred and elaborated specific[redacted] that if the repairs were completed for less than what was estimated, there was a possibility there would be no additional payment for depreciation. We further advised that the roof had been damaged by wind and because of this the windstorm/hail deductible applied.
We received a separate email from Mr. [redacted] on March 16, 2017 regarding the skylights. The email included a forwarded message from Mr. [redacted] to the agent on March 15, 2017 in response to Mr. [redacted] advising the insured that we would need the supplement request for the skylight in writing. Mr. [redacted] expressed frustration with the length of time it took to get a response and the fact that we were asking his contractor to provide the same explanation that he had previously provided. We responded to Mr. [redacted]’s email advising that there had been no storm related damage found to the skylight and that if the contractor was stating that the skylight needed replacement due to wear and tear, then this would not covered and faulty construction would be excluded as well.
On April 3, 2017 we requested a category breakdown summary from the [redacted] adjuster and sent a copy to Mr. [redacted] and Mr. [redacted] per Mr. [redacted] request. We advised that we would need a detailed copy of his contractor’s estimate if there were any discrepancies to allow us to review.
Mr. [redacted] responded to our April 3, 2017 email on the same date and questioned the cost breakdown of the estimate as well as the depreciation.
We responded to Mr. [redacted] via email on April 4, 2017. In our email, we clarified the cost breakdown Mr. [redacted] was interpreting. We also provided clarification on the application of depreciation and the deductible. With regard to the deductible, we advised that any loss caused by wind or hail was subject to the windstorm/hail deductible and that a loss caused by anything other than wind or hail would be subject to the all other perils deductible.
Mr. [redacted] replied via email on the same date inquiring that if replaced the roof, would he be paid the amount of recoverable depreciation that was withheld.  The insured further asked who to send that information to.
We responded via email on April 5, 2017 clarifying that once the roof was replaced, and they had incurred the replacement cost, a claim for recoverable depreciation could be made. We continued with examples of replacement cost totals and how they would affect the amount recoverable if incurred. We also attached a copy of our settlement letter from February 24, 2017 that explained the recoverable depreciation and how to make a claim for it.
On July 2, 2017 Mr. [redacted] submitted his final invoice for the replacement of the roof totaling $9,798.00. His email indicated that he was expecting payment for depreciation based on the amount he spent per his understanding of recoverable depreciation.
The [redacted] adjuster, Mr. [redacted], was enlisted to review the insured’s recoverable depreciation claim and respond to Mr. [redacted]. Mr. [redacted] correctly identified that Mr. [redacted] spent less to repair his roof than the Actual Cash Value of the loss that had already been paid, and therefore no payment for depreciation was due. This was communicated to Mr. [redacted] via email on July 10, 2017. This prompted Mr. [redacted] to send an email outlining his disagreement with our handling of the claim as well as the multiple answer’s he claimed to have received over the course of the claim.
We responded via email to Mr. [redacted] email on July 12, 2017 addressing his concerns as to the depreciation, deductible and the skylights. We offered to send a copy of his policy and provided contact information for further follow up. We further requested he provide us with the documentation for the skylights as they are not in our claim file.
At this point we are awaiting the requested information from the insured.
We hope our actions and efforts satisfactorily answer your inquiry.  If additional information is needed please feel free to contact our office.
 
Sincerely,
 
 
[redacted]
Vice President, Marketing